Biomedical subjects

Hans-Ulrich Wittchen

Publications and source records attributed to Hans-Ulrich Wittchen.

At least 19 recordsLinked to original sources

PubMed2003

Smoking increases the risk of panic: findings from a prospective community study.

BACKGROUND: We examined prospectively determined bidirectional associations between smoking and panic and other anxiety disorders and their temporal ordering of onset in a representative community sample of adolescents and young adults. METHODS: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, panic attacks, panic disorder, other anxiety disorders, and other mental disorders using the Munich-Composite International Diagnostic Interview. RESULTS: At baseline, panic attacks and panic disorder were strongly associated with occasional and regular smoking and nicotine dependence (odds ratio [OR] range, 3.0-28.0). In the prospective analyses, we found increased risk for new onset of panic attacks with prior regular smoking (OR, 2.9; 95% confidence interval [CI], 1.0-8.4) and nicotine dependence (OR, 3.6; 95% CI, 1.2-10.5). Prior nicotine dependence increased also the risk for onset of panic disorder (OR, 3.3; 95% CI, 1.0-10.5), whereas preexisting panic was not associated with subsequent smoking or nicotine dependence. When using Cox regression with time-dependent covariates, prior nicotine dependence was confirmed to be related to subsequent panic attacks (hazard ratio, 2.7; 95% CI, 1.7-4.2), but not panic disorder (hazard ratio, 1.7; 95% CI, 0.7-3.9). Rather, we found indications that prior panic attacks/disorder might also have an effect on secondary development of nicotine dependence. CONCLUSIONS: In young adults, prospective analyses revealed a fairly unique and specific, unidirectional relationship between prior smoking and increased risk for subsequent panic attacks/disorder. However, we could not exclude the existence of a second, less frequent, reverse pathway of prior panic and secondary nicotine dependence.

Adolescent↗

PubMed2003

The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys.

Absence of a common diagnostic interview has hampered cross-national syntheses of epidemiological evidence on major depressive episodes (MDE). Community epidemiological surveys using the World Health Organization Composite International Diagnostic Interview administered face-to-face were carried out in 10 countries in North America (Canada and the US), Latin America (Brazil, Chile, and Mexico), Europe (Czech Republic, Germany, the Netherlands, and Turkey), and Asia (Japan). The total sample size was more than 37,000. Lifetime prevalence estimates of hierarchy-free DSM-III-R/DSM-IV MDE varied widely, from 3% in Japan to 16.9% in the US, with the majority in the range of 8% to 12%. The 12-month/lifetime prevalence ratio was in the range 40% to 55%, the 30-day/12-month prevalence ratio in the range 45% to 65%, and median age of onset in the range 20 to 25 in most countries. Consistent socio-demographic correlates included being female and unmarried. Respondents in recent cohorts reported higher lifetime prevalence, but lower persistence than those in earlier cohorts. Major depressive episodes were found to be strongly co-morbid with, and temporally secondary to, anxiety disorders in all countries, with primary panic and generalized anxiety disorders the most powerful predictors of the first onset of secondary MDE. Major depressive episodes are a commonly occurring disorder that usually has a chronic-intermittent course. Effectiveness trials are needed to evaluate the impact of early detection and treatment on the course of MDE as well as to evaluate whether timely treatment of primary anxiety disorders would reduce the subsequent onset, persistence, and severity of secondary MDE.

Adolescent↗

PubMed2003

Association chain graphs: modelling etiological pathways.

Multiple time-dynamic and interrelated risk factors are usually involved in the complex etiology of disorders. This paper presents a strategy to explore and display visually the relative importance of different association pathways for the onset of disorder over time. The approach is based on graphical chain models, a tool that is powerful but still under-utilized in most fields. Usually, the results of these models are displayed using directed acyclic graphs (DAGs). These draw an edge between a pair of variables whenever the assumption of conditional independence given variables on an earlier or equal temporal footing is violated to a statistically significant extent. In the present paper, the graphs are modified in that confidence intervals for the strengths of associations (statistical main effects) are visualized. These new graphs are called association chain graphs (ACGs). Statistical interactions cause 'edges' between the respective variables within the DAG framework (because the assumption of conditional independence is violated). In contrast they are represented as separate graphs within the subsample where the different association chains may work within the ACG framework. With this new type of graph, more specific information can be displayed whenever the data are essentially described only with statistical main- and two-way interaction effects.

Alcoholism↗

PubMed2003

Risk factors for depression at 12-month follow-up in adult primary health care patients with major depression: an international prospective study.

BACKGROUND: The aim of this study was to identify internationally relevant risk factors for the persistence of depression in primary care. None of the previous studies examining primary care patients could examine an equivalently large international sample. The findings from the WHO Collaborative Study on 'Psychological Problems in General Health Care' might be generalised to different cultural environments. METHODS: A primary care sample of depressed subjects (ICD-10) (n=725) from 15 centres from all over the world was reinvestigated for the presence of depression after 12 months. Logistic regression analysis was used to determine the relationship of sociodemographic variables, characteristics of mental illness, and social disability with depression at follow-up. RESULTS: 33.5% of the subjects met ICD-10 criteria for a current depressive episode at the 12-month follow-up. Logistic regression analysis revealed that years of formal education, unemployment, depression severity, antidepressant use, abdominal pain as the main reason for consulting the general practitioner, and 'Repeated suicidal thoughts' were related to depression after 1 year. LIMITATIONS: We have only poor information about details of the actual course of patients between the two assessments. CONCLUSIONS: Our findings of significant variables are generally comparable to results of previously conducted studies. Sociodemographic and disease-specific variables play an important role in the prediction of depression at the 12-month follow-up. General practitioners must be careful in the consideration of these variables but also of individual patient characteristics.

Adolescent↗

PubMed2003

Natural course and burden of bipolar disorders.

Despite an abundance of older and more recent retrospective and considerably fewer prospective-longitudinal studies in bipolar disorders I and II, there are still remarkable deficits with regard to our knowledge about the natural course and burden. The considerable general and diagnosis-specific challenges posed by the nature of bipolar disorders are specified, highlighting in particular problems in diagnostic and symptom assessment, shifts in diagnostic conventions and the broadening of the diagnostic concept by including bipolar spectrum disorders. As a consequence it still remains difficult to agree on several core features of bipolar disorders, such as when they begin, how many remit spontaneously and how many take a chronic course. On the basis of clinical and epidemiological findings this paper summarizes (i) a significant need to extend the study of the natural course of bipolar disorder in clinical samples beyond the snapshot of acute episodes to the study of the mid-term and long-term symptom course, associated comorbidities and the associated burden of the disease. (ii) In terms of epidemiological studies, that are also of key importance for resolving the critical issues of threshold definitions in the context of the bipolar spectrum concept, there is a clear need for identifying the most relevant risk factors for the first onset and those for the further illness progression in early stages. Since there are some indications that these critical processes might start as early as adolescence, such studies might concentrate on young cohorts and clearly before these prospective patients come to clinical attention. (iii) The value of both types of studies might be enhanced, if beyond the use of standardized diagnostic interview, special attempts are made to use prospective life- and episode-charting methods for bipolar illnesses.

Age of Onset↗

PubMed2003

Maternal smoking and smoking in adolescents: a prospective community study of adolescents and their mothers.

The associations between maternal smoking and nicotine dependence and patterns of smoking and nicotine dependence in offspring were examined in a large community-based sample of adolescents. Data were derived from baseline and 4-year follow-up assessments of 938 respondents aged 14-17 years at the outset of the Early Developmental Stages of Psychopathology (EDSP) study, a prospective-longitudinal community study of adolescents and young adults and their parents respectively. Smoking and nicotine dependence in respondents were assessed using the Munich Composite International Diagnostic Interview (DSM-IV algorithms). Diagnostic information about smoking behavior in mothers was collected by independent direct diagnostic interviews with the mothers. In comparison to children of non- or occasionally smoking mothers, children of regularly smoking and nicotine-dependent mothers had higher probabilities of using tobacco as well as of developing nicotine dependence. For all ages under consideration, survival analyses revealed a higher cumulative lifetime risk of regular smoking and nicotine dependence among these children. Maternal smoking during pregnancy seems to represent an additional risk for these outcomes in children, specifically with regard to the risk of developing nicotine dependence. Associations were comparable for sons and daughters. Our findings show that maternal smoking predicts escalation of smoking, development of nicotine dependence, and stability of smoking behavior in children. Implications for specific intervention and prevention efforts are discussed.

Adolescent↗

PubMed2002

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology.

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organization's composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.

Adolescent↗

PubMed2002

What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults.

OBJECTIVES: To determine risk factors of incident onset of use, abuse and dependence of cannabis in a community sample of adolescents and young adults. METHODS: Risk factors were examined in a prospective longitudinal design across 4 years in a representative sample (N = 2,446) aged 14-24 at the outset of the study (EDSP). Patterns of DSM-IV defined cannabis use, abuse and dependence were assessed with the Composite International Diagnostic Interview (M-CIDI). Potential risk factors were assessed at baseline. Incident cannabis use, abuse and dependence at second follow-up (on average 42 months after baseline) were the main outcome measures in this study. Associations were analyzed with logistic and negative binomial regressions. RESULTS: Using 11 of a total of 56 variables examined, the predictive value of the final multiple logistic regression for incident cannabis use was moderately good (area under the ROC curve = 0.78). Cannabis use frequency was predicted in the final model by 18 variables, cannabis abuse by two variables in the younger subsample and nine factors in the older group, and dependence by eight variables (dependence: ROC curve area = 0.97). Incident cannabis use was predicted mainly by availability of drugs, peers' drug use, a more 'positive' attitude towards future drug use, and regular previous use of licit drugs, while cannabis dependence was predicted primarily by parental death before age 15, deprived socio-economic status, and baseline use of other illicit drugs. CONCLUSION: Different factors predict the onset or severity of cannabis use and the progression to abuse and dependence. In addition to well-documented risk factors such as peer group pressure, drug availability, and low self-esteem, findings suggest that family history (e.g. parental mental disorders, early parental death), and prior experiences with legal drugs play a significant role in the initiation of cannabis consumption and the transition to cannabis use disorders in adolescents and young adults. Findings suggest that early intervention and prevention might be improved by better targeted treatment.

Adolescent↗

PubMed2002

Parental major depression and the risk of depression and other mental disorders in offspring: a prospective-longitudinal community study.

BACKGROUND: This article examines associations between DSM-IV depressive disorders, their natural course, other psychopathology, and parental major depression in a community sample of adolescents and young adults. METHODS: Baseline and 4-year follow-up data were used from the Early Developmental Stages of Psychopathology Study, a prospective-longitudinal community study of adolescents and young adults. Results are based on 2427 subjects who completed the follow-up and for whom diagnostic information for both parents was available. DSM-IV mental disorders in respondents were assessed using the Munich-Composite International Diagnostic Interview. Information on depression in parents was collected as family history information from the respondents and from diagnostic interviews with parents of the younger cohort. RESULTS: Offspring with 1 (odds ratio [OR], 2.7; 95% confidence interval [CI], 2.1-3.5) or 2 affected parents (OR, 3.0; 95% CI, 2.2-4.1) had an increased risk for depression. They also had a higher risk for substance use (1 parent affected: OR, 1.4; 95% CI, 1.1-1.7; both parents affected: OR, 1.4; 95% CI, 1.0-1.8) and anxiety disorders (1 parent affected: OR, 1.6; 95% CI, 1.3-1.9; both parents affected: OR, 2.1; 95% CI, 1.6-2.8). There were no differences whether mother or father was affected. Parental depression was associated with an earlier onset and a more malignant course (severity, impairment, recurrence) of depressive disorders in offspring. CONCLUSIONS: Major depression in parents increases the overall risk in offspring for onset of depressive and other mental disorders and influences patterns of the natural course of depression in the early stages of manifestation.

Adolescent↗

PubMed2002

Complex segregation analysis of restless legs syndrome provides evidence for an autosomal dominant mode of inheritance in early age at onset families.

A strong familial component of restless legs syndrome (RLS) is known. The objective of this study therefore was to investigate the likely mode of inheritance of RLS. RLS patients and their first-degree relatives were investigated and classified in RLS affected and RLS nonaffected subjects. Assessments were based on direct, personal standardized diagnostic interviews. Complex segregation analysis was performed with the families stratified according to the mean age at onset of the disease within the families. Two hundred thirty-eight RLS patients, 537 first-degree relatives, and 133 spouses were interviewed. Two groups of families were stratified: mean age at onset up to 30 years of age (Group A) and older than 30 years (Group B; p < 0.005). In Group A, segregation analysis strongly favored a single major gene acting autosomal dominant with a multifactorial component. Parameter estimates were 0.003 for the allele frequency, 1.0 for the penetrance, and 0.005 for the phenocopy rate. In Group B, no evidence for a major gene could be elucidated. The segregation pattern found in our families argues for an autosomal allele acting dominantly in RLS families with an early age at onset of symptoms and suggests that RLS is a causative heterogeneous disease.

Adolescent↗

PubMed2002

Generalized anxiety disorder: prevalence, burden, and cost to society.

Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterized by persistent worrying, anxiety symptoms, and tension. It is the most frequent anxiety disorder in primary care, being present in 22% of primary care patients who complain of anxiety problems. The high prevalence rate of GAD in primary care (8%) compared to that reported in the general population (12-month prevalence 1.9-5.1%) suggests that GAD patients are high users of primary care resources. GAD affects women more frequently than men and prevalence rates are high in midlife (prevalence in females over age 35: 10%) and older subjects but relatively low in adolescents. The natural course of GAD can be characterized as chronic with few complete remissions, a waxing and waning course of GAD symptoms, and the occurrence of substantial comorbidity particularly with depression. Patients with GAD demonstrate a considerable degree of impairment and disability, even in its pure form, uncomplicated by depression or other mental disorders. The degree of impairment is similar to that of cases with major depression. GAD comorbid with depression usually reveals considerably higher numbers of disability days in the past month than either condition in its pure form. As a result, GAD is associated with a significant economic burden owing to decreased work productivity and increased use of health care services, particularly primary health care. The appropriate use of psychological treatments and antidepressants may improve both anxiety and depression symptoms and may also play a role in preventing comorbid major depression in GAD thus reducing the burden on both the individual and society.

Adolescent↗

PubMed2002

Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study.

'Depression 2000' is a major epidemiological study conducted in a representative sample of 412 primary care settings (which examined a total of 15,081 unselected patients) in Germany in order to address the current lack of information on the prevalence, recognition and treatment of depression in primary care. The study revealed that depression is a key challenge in primary care because of its prevalence (point prevalence according to ICD-10: 10.9%), type of presenting complaints and the time constraints of the doctors. Participating doctors had a very high workload (average of 62 patients per day) and perceived the management of depressed patients as a major burden. The majority of cases of depression identified met criteria for moderate or severe depression, and 51% had a chronic and/or recurrent course. A total of 55% of patients were correctly diagnosed as having a clinically significant depressive disorder, although only 21% received a diagnosis of 'definite' depression. In conclusion, these findings confirm the high prevalence of depressive disorders in primary care settings and underline the particular challenges posed by these patients. Although recognition rates among more severe major depressive patients, as well as treatments prescribed, appear to be more favourable than in previous studies, the high proportion of unrecognised patients with definite depression still raises significant concerns. It remains of continued prime importance to educate primary care doctors to better recognise depression in order to increase the patients' chances of receiving appropriate treatment.

Adolescent↗

PubMed2002

Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey.

This paper outlines the principal aims and design of the German National Health Interview and Examination Survey, mental health supplement (GHS-MHS), the first nationwide, epidemiological study of both somatic and mental health in Germany on a representative sample of 4,181 subjects in the community. Both the broader context of the study--in particular its methodological relation to the social and somatic core survey of the German National Health Interview and Examination Survey (GHS-CS)--and the internal methodology of the mental health supplement (GHS-MHS) are presented. The study's strategies and method are derived from a consideration of important theoretical issues arising from epidemiological studies in the field of public health. The main instrument used to assess diagnoses of mental disorders was a standardized diagnostic interview for mental disorders (following DSM-IV (CIDI)) applied by clinically trained interviewers. This diagnostic interview was supplemented by modules on comorbidity, help seeking, treatment and impairment. Somatic health diagnoses were made using an integrated approach including self-report measures, a standardized clinical interview, and laboratory measures. Findings on sampling, response rate, weighting and sample characteristics are presented. Critical issues are discussed, including the scientific objectives that have been achieved by the study. Overall, the GHS core survey and its mental health supplement provide the mental health research community with complex data that allow for high-quality analysis of mental disorders and associations with somatic disorders.

Adolescent↗

PubMed2002

Patterns of incidence and psychiatric risk factors for traumatic events.

Individual differences are thought to influence the propensity for exposure to trauma and the subsequent development of post-traumatic stress disorder (PTSD) symptoms. Prior research has identified pre-existing mood disorders as one such individual risk factor for traumatic events as well as for PTSD. The present study reports the incidence of traumatic events (and PTSD) and examines psychiatric risk factors for trauma exposure in a prospective community sample. Data come from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24) in Munich, Germany. Respondent diagnoses (N = 2,548) at baseline and at follow-up 34-50 months later were considered. Psychiatric diagnoses at baseline were examined as predictors of qualifying trauma. Baseline prevalence of persons having experienced trauma meeting DSM-IV A1 and A2 criteria ('qualifying trauma') was 16.7%; during the follow-up period, 20.3% persons had experienced incident (new) qualifying traumata. The prevalence of PTSD, including subthreshold cases, at baseline was 5.6%; by the end of the follow-up period this had increased to 10.3%. Presence of an anxiety disorder at baseline predicted exposure to qualifying traumas during the follow-up period (adjusted ORs ranging from 1.36 for any trauma type to 3.00 for sexual trauma); this association was apparently due to an increased tendency to report events as being particularly horrific (meeting A2 criteria). In contrast, presence of illicit drug use predicted the onset of traumatic events (specifically assaultive and sexual trauma) meeting at least A1 criteria, suggesting an actual exposure to these types of traumatic events for this class of disorders. In this prospective study of urban adolescents and young adults, certain classes of pre-existing psychiatric disorders (most notably anxiety disorders and illicit drug use disorders) were associated with increased risk for qualifying traumatic events. The mechanisms by which premorbid psychiatric disorders promote exposure to traumatic events are unknown. Better understanding of these pathways may lead to novel strategies for primary and secondary prevention of PTSD.

Adolescent↗

PubMed2002

Life events and changes in the course of depression in young adults.

BACKGROUND: Few community-based studies have examined the impact of life events, life conditions and life changes on the course of depression. This paper examines associations of life events on depressive symptom onset, improvement, and stability. METHODS: Direct interview data from the Early Developmental Stages of Psychopathology Study (EDSP), a 4-5 year prospective-longitudinal design based on a representative community sample of adolescents and young adults, aged 14-24 years at baseline, are used. Life events were measured using the Munich Event-Questionnaire (MEL) consisting of 83 explicit items from various social role areas and subscales for the assessment of life event clusters categorized according to dimensions such as positive and negative and controllable and uncontrollable. Depressive disorders were assessed with the DSM-IV version of the Munich Composite Diagnostic Interview (M-CIDI). Multiple logistic regression analyses examined the effects of 22 predictors on the course of depression (onset, improvement, stability). RESULTS: Younger age, low social class, negative and stressful life events linked to the family were associated with increased risk of new onset of depression. Anxiety was a significant independent predictor of new onset of depression. Absence of stressful school and family events was related to improvement in depression. The weighted total number of life events predicted stable depression. CONCLUSIONS: The association between life events and the course of depression appears to vary according to the outcome being examined, with different clusters of life events differentially predicting onset, improvement, and stability.

Adolescent↗

PubMed2002

Generalized anxiety disorder: comorbidity, comparative biology and treatment.

Generalized anxiety disorder (GAD) is a severe and chronic anxiety disorder characterized by uncontrollable worrying and somatic anxiety (tension, insomnia and hypervigilance). It is a common condition, with lifetime prevalence rates for DSM-IV GAD in the general population of approx. 5-6% being reported. In addition, like other anxiety disorders, GAD also shows comorbidity with depression and most of the other anxiety disorders. This article reviews data on the prevalence of GAD, its comorbidity with depression, and its social and economic impact. Proposed neurobiological mechanisms for GAD are discussed, since an understanding of these may help in the development of future therapies. Finally, current pharmacological and non-pharmacological treatment options for GAD are reviewed, with particular attention being paid to published clinical-trial data.

Anti-Anxiety Agents↗

PubMed2002

Test-retest reliability of self-reported age at onset of selected psychiatric diagnoses in general health care.

OBJECTIVE: To investigate reliability of self-reported age at onset of frequent mental disorders and its association with patient and disorder characteristics. METHOD: A total of 1031 primary care patients with at least one lifetime psychiatric diagnosis were asked to report age at onset of their disorders at baseline and after 1 year. Intraclass correlation coefficients (ICC) for age at onset information were calculated for individual disorders. RESULTS: ICC were high and lay between 0.6790 (generalized anxiety disorder) and 0.7977 (dysthymia). Factors associated with reliability are different for different disorders: gender for depressive episodes, gross national product per year per inhabitant for dysthymia, age for pain disorder, years of formal education for dysthymia, generalized anxiety disorder, and agoraphobia, and number of lifetime diagnoses for depression and agoraphobia. CONCLUSION: Self-reported age at onset is reliable. Further research on factors associated with reliability should focus on interview conditions and subject parameters during interview.

Agoraphobia↗

PubMed2002

Generalized anxiety and depression in primary care: prevalence, recognition, and management.

AIMS: Determine attitudes toward patients with generalized anxiety disorder (GAD) and major depressive episodes (MDE) in primary care; determine prevalence of GAD, MDE, and comorbid GAD/MDE among primary care patients; assess physician recognition of GAD and MDE; and describe primary care interventions for these patients. METHOD: 558 primary care physicians participated in a 1-day survey. Over 20,000 patients completed a diagnostic-screening questionnaire for GAD and MDE. Physician questionnaires included a standardized clinical appraisal of somatic and psychosocial symptoms and information on past and current treatments and a prestudy questionnaire assessing experience with and attitudes toward patients with GAD and MDE. RESULTS: 56.9% of physicians viewed GAD as a genuine mental disorder with clinical management problems and considerable patient burden; 27.4% treated GAD patients differently from MDE patients. 5.3% of patients met criteria for GAD, 6.0% for MDE, 3.8% for pure GAD, 4.4% for pure MDE, and 1.6% for comorbid GAD/MDE. Pure GAD and MDE were associated with disability, high utilization of health care resources, and suicidality, which were even higher with comorbid GAD/MDE. Physicians recognized clinically significant emotional problems in 72.5% of patients with pure GAD, 76.5% with pure MDE, and 85.4% with comorbid GAD/MDE. However, correct diagnosis was much lower (64.3% for MDE and 34.4% for GAD). Although the majority of patients with recognized GAD or MDE were treated, only a small minority with GAD were prescribed medications or referred to specialists. CONCLUSION: The high proportion of respondents with pure GAD is inconsistent with previous reports that GAD is usually comorbid with depression. GAD remains poorly recognized and inadequately treated. Improving the recognition and treatment of GAD in primary care patients is discussed relative to new treatments.

Adolescent↗